Job Description

JOB SUMMARYHospital Outpatient Coding:The Hospital Coding Specialist ll reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes for billing, internal and external reporting, research, and regulatory compliance activities. This individual accurately codes outpatient conditions and procedures as documented in the medical record and applying the ICD Official Guidelines for Coding and Reporting. The Hospital Coding Specialist II provides charge validation and capture processes for various patient types. This individual assigns codes for diagnoses, treatment, and procedures according to the appropriate classification system for outpatient encounters. The Hospital Coding Specialist II utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD diagnoses, ICD CPT/HCPCS codes including modifier assignment. This individual validates and/or identifies chargeable items for various patient types (i.e., OBS, SDS) and enters them into the billing system to include the following outpatient visit types: Ambulatory surgery (same day surgery), may include charge capture; Observation service encounters; Other hospital outpatient types in accordance with Coder II job descriptions, as assigned.Hospital Inpatient Coding:The Hospital Coding Specialist II accurately codes inpatient conditions and procedures as documented in the International Classification of Diseases (ICD) Official Guidelines for Coding and Reporting and in the Uniform Hospital Discharge Data Set (UHDDS) and assignment of the appropriate MS-DRG (Medicare Severity-Diagnosis Related Group) or APR-DRG (All Patients Refined Diagnosis Related Groups) for complex, multi-specialty inpatient services. This individual understands and applies applicable medical terminology, anatomy and physiology, surgical technology, pharmacology, and disease processes. The Hospital Coding Specialist II reviews professional and hospital inpatient medical record documentation and properly identifies and assigns: ICD CM and PCS codes for all reportable diagnoses and procedures including principal diagnosis, co-morbidities and complications, secondary conditions, surgical procedures and/or other procedures; MS-DRG /APR-DRG; Present on admission indicators; HAC (Hospital Acquired conditions) and when required, report through established procedures; PSI conditions and report through established procedures; Discharge Disposition code. Works collaboratively with the Clinical Documentation Improvement Specialists to address documentation concerns and DRG assignments. Assists in the preparation of responses to DRG validation requests and other third party payer inquiries related to coding and DRG assignments as requested.JOB QUALIFICATIONSEDUCATION: Minimum Required: Medical Coding Diploma or American Health Information Management Association (AHIMA) approved Health Information Management Degree or related program.EXPERIENCE: Minimum Required: Two years of coding and reimbursement experience in a multi-specialty setting clinic/hospital or completion of coding degree or diploma will be considered in addition to knowledge of medical terminology, anatomy and physiology, pharmacology, disease process, and surgical procedures; knowledge of accepted medical abbreviations and their meanings; knowledge in the use of specialized references such as the ICD and CPT-4 books, medical dictionaries and texts, and medical journals; extensive knowledge of Coding Clinic, CPT Assistant and all official coding guidelines; advanced knowledge of hospital information systems, encoders and other technology to facilitate a successful work environment while maintaining maximum communication and adhering to HIPAA security standards; advanced knowledge of Microsoft Outlook, Excel and Word functions; technical skills required to learn and navigate a variety of software systems and troubleshoot computer problems; strong written and verbal communication skills; ability to think and work independently, yet interact positively with team; advanced problem solving skills; attention to detail.CERTIFICATIONS/LICENSES: Minimum Required: AAPC (American Academy of Professional Coders) or AHIMA (American Health Information Management) credential (i.e., CCS, CCS-P, RHIT, RHIA, CCA, CPC, CPC-H, COC) within one year of hire.Remote work is supported in specified US states only. Marshfield Clinic Health System will not employ individuals living in states not listed.Marshfield Clinic Health System is committed to accessible, affordable and compassionate healthcare and is an Equal Opportunity/Affirmative Action employer.

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